Vaccine rollout lessons put on hold

Jolyon Attwooll

18/08/2022 11:47:52 AM

An Audit Office report contains criticisms of planning and communication but offers few concrete suggestions for improvement.

Woman being vaccinated
General practices were at the heart of the COVID-19 vaccine rollout in Australia.

Detailed lessons from the vaccine rollout – which has involved thousands of GPs around the country – will need to wait until another more extensive review takes place, according to the Australian National Audit Office (ANAO).
A 112-page ANAO report, Australia’s COVID-19 Vaccine Rollout, was publicly released on Wednesday afternoon.
While it reached conclusions on some aspects of the operation – described as one of the largest exercises in health logistics in Australian history – one of two recommendations is for a further ‘comprehensive review of the rollout to identify opportunities for improvement in the event of a future vaccine rollout’.
The ANAO is critical of early planning, as well as the program’s success in reaching priority groups, calling the program ‘partly effective’ and noting that its planning became ‘more effective’ as the rollout progressed.
The report does reference the impact of the rollout on primary care but contains no concrete suggestions for improvements on the approach for this sector, which has now seen general practices delivering 31,334,460 vaccine doses since the program began.
More than 90% of the Australians over the age of 12 had received two doses of the vaccine, the ANAO report stated.

It also acknowledges the way that fundamental shifts in the approach were announced was problematic for those most impacted, referencing how former Prime Minister Scott Morrison would inform media of policy changes directly after they were agreed with state and territory leaders.
‘As a result, some policy changes relating to the vaccine rollout were announced publicly before they were communicated to operational staff and key stakeholders,’ the report states.
‘Stakeholders in the primary care sector advised the ANAO that coordination bodies and individual primary health administrators were not always prepared to implement the changes or respond to patients’ questions.
‘Primary care stakeholders advised this reduced public trust and created other difficulties for administration providers.’
RACGP President Adjunct Professor Karen Price says examining the way in which Government communicated with general practice should be high on the next review’s agenda.
‘One of the most frustrating parts of the rollout was learning about eligibility changes via our patients or a press conference on TV,’ she said.
‘It must also get to the bottom of why practices reported many logistical failings such as vaccines not arriving on time or fewer doses received than ordered.
‘Last but certainly not least, we must have greater GP representation at all levels of government and policy making in response to not only pandemics, but other disasters impacting the health of the community.’
The RACGP contributed to the inquiry with a 14-page submission last November. As well as advocating for improved Government communication, both with the public and general practice, the college cited the failure to reach priority populations as another key concern.
‘While Aboriginal and Torres Strait Islander people, residential aged care workers and people with disability, were all identified as priority populations, access to the vaccine and vaccine education for these groups was a challenge and some of these challenges are still to be overcome,’ the college report read.
The ANAO report also identifies this area as a particular weakness.
‘Health underestimated the magnitude and complexity of rolling out in-reach services for the residential aged care and disability sectors and did not engage sufficient in-reach providers early in the rollout,’ it states.
The auditor investigators are particularly critical of early planning, referencing an absence of concrete action as the work to finalise the vaccines and their approval with regulatory bodies reached a critical stage late in the first year of the pandemic.
‘The commencement of planning for the rollout was not timely and early planning did not include target dates for the rollout,’ the report reads.
‘Detailed engagement with the states and territories on rollout planning did not begin until November 2020 and Jurisdictional Implementation Plans were not agreed until February 2021, by which time the rollout of COVID-19 vaccines had already commenced.’
It notes substantial improvements to the rollout following the establishment of Operation COVID Shield in June 2021 under Lieutenant General John Frewen.
‘Following the commencement of Operation COVID Shield in June 2021, senior level oversight of the program substantially increased,’ the ANAO writes.
‘Health regularly consulted with four sector-specific stakeholder advisory groups … [and] put in place effective monitoring and reporting arrangements using the best available data.
‘However, it did not undertake sufficient reporting against targets, and it does not have adequate assurance over the completeness and accuracy of the data and third-party systems.’
As well as a further review, the ANAO also recommends that the Department of Health and Aged Care (DoH) establish improved data quality and IT controls.
The DoH has agreed to both recommendations, with the more extensive review planned by the end of the year, and stakeholder contributions due to be invited again.
Professor Price hopes further work will take account of the role of general practice and GPs’ insights into the efficacy of the rollout.
‘Our voice must be heard if we are to learn from this experience and ensure the next mass vaccination rollout doesn’t run into the same old problems,’ she said. 
‘I look forward to the RACGP playing a prominent role in the Government’s review.’
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